Clary sage (Salvia sclarea) essential oil use during childbirth: a small survey

Whilst researching the effects of essential oils for the Aromatherapy for Childbirth study day which my colleague Jude Davis and I provide, we discovered that essential oil of Clary sage had little evidence supporting its use for inducing or easing labour. Despite this, the midwives, doulas and others working in childbirth attending our course tend to uphold the ‘common knowledge’ that using Clary sage often benefits labouring women. In our course, we teach what is thought to be the benefits of using this essential oil and advise cautions surrounding its use in certain instances, however the dearth of research leaves us all currently practising more according to opinion and ancient wisdom, than to evidence in this area.

Essential Oils Safety (2013) co-author Robert Tisserand (4) recently stated that he had ‘not seen a single case account of Clary Sage oil inducing labour. I’m open to the possibility, but I would want to see some kind of evidence’. He also noted the important point that Burns (2000) large study reported no undesirable effects from aromatherapy intervention in maternity care. Visiting the study finds that although Burns et al do not find the “practice of aromatherapy per se reduces the need for pain relief during labour”, it suggests that clary sage is effective in alleviating pain.

Curious for further information, we offered via our Facebook page (1) and our website blog (2) a small survey (3) which, with just 28 responses, already shows some interesting information.

The online survey was open to midwives, students, doulas, other birth attendants and mothers who had experienced or observed Clary sage use in childbirth. Many thanks to all those who took part in it.

Results from 28 respondents:Thirteen had used Clary sage as a midwife, doula or birth helper, 9 women had used it on themselves, 6 had both used it on themselves and others.

Over three quarters, 22, of the respondents liked its smell, 3 people didn’t enjoy it and one person attributed their headache to it.

All responders believed Clary sage helped with relaxation to some degree with twelve finding it ‘very good’ and 5 to be ‘excellent’

Contractions effect: sixteen stated onset of contractions had occurred following the use of Clary sage. Over three quarters of those surveyed believed that clary sage had made contractions stronger and more frequent. 3 people perceived a reduction in pain whilst 2 people saw no difference in contractions after using it. Interestingly, no one saw or experienced an increase in pain with the use of Clary sage, despite the increased perception in strength of contractions.

Experiences were shared of Clary sage use aiding women into active labour after long latent stages following massage or bathing with the essential oil. Other respondents had found Clary sage aided transition and second stage of labour.

Overall how much do you think clary sage helps women and labour?

Average response to the question on a scale of between one and a hundred was 74.

Thoughts on how clary sage can help labour and why it is thought to work: Comments offered include the following thoughts and advice:

‘It works wonderfully to bring on or build uterine activity. A little amount goes a long way’.

‘It is also a very good relaxant and I noticed immediate effects of relaxation on myself and still do whenever I smell it’.

It has quite a sedating effect which potentially has a positive impact on reducing adrenaline and therefore aids oxytocin production

Ensure she is hydrated, nourished with energy foods, rested, relaxed, that the baby is well positioned (head not high, optimal positioning etc. if possible), using other oils to relax and support emotions first THEN try clary sage.

Methods of use: 18 smelled clary sage directly from bottle, gauze, tissue, scent stick, cloth etc. Application by tapers were found to be useful as they could be removed if the effect was too strong. 17 used a diffuser whilst 16 used a massage blend of 1 or 2% dilution. 10 used essential oils in the bath, whilst 6 used compresses.

One person massaged 1% blend of clary sage onto acupressure points and reported strong and regular contractions starting within ten minutes of use. Another found it helped to increase the strength and frequency of contractions every time. One report of indirect use via a burner was not found to be helpful.

Contraindications: considering the scarcity of research indicating the benefits or potential harms of using Clary sage in aromatherapy for childbirth, there is a surprising abundance of proposed contraindications to its use identified by this small survey.

Responders cautioned that Clary sage should not be used ‘when pregnant’, in the ‘first trimester’, ‘when not in labour’ or when ‘in preterm labour’. There was also concern regarding use before various weeks of gestation including ‘34’, ‘37’, and ‘38’, due to the supposed risk of stimulating labour.

Contraindicated was also thought to be those with ‘previous caesarean section’, ‘low lying placenta’, ‘on an antenatal ward’, undergoing ‘Induction of labour’ or ‘for 30 minutes following ARM’ (Artificial Rupture of Membranes).

Some proposed that Clary sage should be used ‘only on low risk women’ and others felt that its use should be discontinued if labour was well established, or if the uterus was hyper-stimulated. Also suggested was that that it should not be used ‘If there is not going to be a normal delivery because of a complication eg low lying placenta’, ‘whilst using syntocinon antenatally’, with ‘hypertension’ or with ‘other maternal complications’.

Clary sage influence on others beside the birthing mother. Just 11 responders believed it did influence others, 10 did not think it did and 7 weren’t sure.

Comments about clary sages’ influence on others were mainly positive, except for the one report of a headache. They included: ‘calming a student midwife’ and ‘calming a tense and noisy atmosphere by showing a partner how to massage with clary sage when the atmosphere in the room was very tense and noisy previously’. Several times it was thought that Clary sage influenced the birth partners through relaxation, focus and clarity. Mothers of clients became calmer. Someone said it was ‘very hypnotic, helped the focus’, also that it has the ability to ‘lift the energy of the room when there is confusion, panic and fear’.

Overall 26/28 felt that clary sage was of positive use in labour and 2 thought it was maybe of use. No one thought it was of no use.

The comments included that Clary sage is useful alongside therapeutic touch. Interestingly, one response read: ‘I think once in labour it would be too late to influence the strength and frequency of surges but could help with relaxation to encourage a more relaxed labour and this may influence the surges’. Whilst one wrote that it would ‘help bring on/strengthen contractions in early labour and to restart stalled labour’. Another stated ‘it worked on me by stopping irregular tightenings and letting me rest. When they restarted a few hours later they were more intense’.

One birth helper wrote that as an intervention it was gentle and helped support the birth helpers if used sensitively. It aids relaxation with an analgesic effect, and finally one person said, “I just loved the smell if nothing else”.

This was a small self-selected study of those who felt inclined to share their experiences by completing our survey. Numbers were low, and this is part is due to our lack of technical wizardry, as participants needed to click on a few links to access the survey. However, it does add up to many hours of experience of using Clary sage in labour and an overwhelmingly positive perception that this essential oil helps women in childbirth.

The results indicate that we could benefit from research into how Clary sage may influence the psychology and physiology of labour via both indirect and direct use. Several contradictions are seen in the responses to our survey about which women are deemed suitable to use Clary sage and at which stages of pregnancy it should be used. Further research may yield more clarity on its affects by attempting to understand what, if any, contradictions should be advised with the use of clary sage. Without this, women who may benefit from its use may currently be prevented from doing so without sound reason.

At the same time as calling for new studies, there’s an awareness that ‘evidence’ relating to healthcare is rarely as robust as we’d like to think. Marsden Wagner in his excellent, freely available, ‘Fish can’t see water’ (2001) paper explained taking birth out of the home and into the hospital with its unfamiliar people and use of machines had an overwhelming influence on childbirth itself. So much so that much of our ‘evidence’ surrounding the subject is deeply flawed for having been collected in such an impactful environment with so much disturbance of the natural process. Guideline writers uphold randomised controlled trials as ‘gold standard’ and yet these large studies lack insight into the lived experience whilst smaller subjective studies are often deemed less worthy due to a lack of numbers involved. Clary sage has a distinctive aroma and aromatherapy cannot be provided unknowingly to ‘control’ and ‘blind’ testing. However, despite the challenges and limitations of research, a move towards a deeper understanding of Clary sage may help to address the confusion about contraindications and reduce the opinion-based and risk-centred aversion to its use in certain instances, and perhaps a more widespread beneficial use of this oil which lacks science but has an impressive reputation for being helpful in birth.

This survey is still open

If you have used clary sage or seen it used during labour, please share your experience to help us continue to gather further data and knowledge. You don’t need to be an expert! Thank you.